the
freckle is a small pigmented lesion that is distinctly associated with sun exposure. the patient may report worsening with sun exposure and lightening with sun avoidance. an autosomal dominant inheritance is likely, so that patients can be questioned about familial involvement.
freckles are a strong risk indicator for melanoma and nonmelanoma skin cancers; patients should be questioned about new or changing moles and non-healing lesions.
freckles do not involve mucous membranes. they are most common in individuals with type i and ii skin, and blonde or red hair. axillary or inguinal freckling (crowe’s sign) should prompt a complete skin examination and review of systems to rule out neurofibromatosis.
biopsy, although rarely necessary, shows keratinocytes with increased melanin content, likely secondary to enlarged melanosomes in the basal layer. there is no increase in the number of
melanocytes.